Provider Demographics
NPI:1689843179
Name:BEHAVIORAL MEDICINE ASSOCIATES INC
Entity Type:Organization
Organization Name:BEHAVIORAL MEDICINE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:TEARNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:775-827-8883
Mailing Address - Street 1:5470 KIETZKE LN STE 300
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2099
Mailing Address - Country:US
Mailing Address - Phone:775-827-8883
Mailing Address - Fax:866-476-4317
Practice Address - Street 1:5470 KIETZKE LN STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2099
Practice Address - Country:US
Practice Address - Phone:775-827-8883
Practice Address - Fax:866-476-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPSY142103TC0700X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty